ABSTRACT
Background: Cirrhosis is a long-term inflammatory process of hepatic tissue condition that mainly affects people aged 50 to 60. This study aims to assess Left ventricular diastolic dysfunction (LVDD) in cases with cirrhotic liver by conventional, tissue Doppler and two-dimensional speckle tracking echocardiography to clarify the correlation between the severity of cirrhotic liver and LVDD. Methods: A prospective case-control research involved 100 adult cases with confirmed HCV and HBV. Cases were divided into 4 equal group: Group A: Child A cases, group B: Child B cases, group C: Child C cases and group D (Controls): healthy non-hepatic subjects of the same age and sex who have normal blood pressure, nonsmoking participants with no further concomitant problems. Results: Number of cases with LVDD had a statistical noticeable increase in Child A, B, and C (p =0.004, <0.001, and <0.001 respectively. LAVi had a statistical noticeable increase in Child C / B (p =0.013 and p =0.014). Conclusion: Left atrial volume index (LAVi) had a statistical noticeable increase in Child C / B in comparison to the controls but E m, E l were statistical noticeable lower in Child C / B. /E had a statistical noticeable increase in Child C group, LVSRe had a statistical noticeable decrease in Child C group but it was insignificantly different across Child A / B/ C and controls and across Child B / C and controls.
ABSTRACT
Background: Acute right ventricular dysfunction (RVD) is a leading cause of death in the setting of acute pulmonary embolism (PE). Therefore, several studies investigated the predisposing factors of RVD. However, at present, little is known about the clinical predictors of RVD in the patients presented with acute PE. Objective: To assess the association of CHA2DS2-VASc Score with the PE severity, RVD and the in-hospital mortality in patients presented with acute PE. Methods: This study was conducted on 50 patients admitted with acute PE at Tanta University Hospitals. We studied the association of different variables including demographic data, common risk factors, clinical presentation, management and the in-hospital mortality with the PE clinical subgroups (massive, sub-massive and non-massive) based on the severity of clinical presentation and also the association of these variables with the thromboembolic risk (high, moderate and low) based on the CHA2DS2-VASc scores. The independent predictors of the RVD were then investigated by the univariate and multivariate regression analyses. Results: The massive PE presentation was associated with higher CHA2DS2-VASc scores (P value = 0.02). Also, the incidence of RVD was higher among the high risk group of patients (CHA2DS2-VASc scores ?3) with P value = 0.009. TAPSE, MPI, FAC, and E`/A` ratio were found to be more significant in the high risk group (P value = 0.032, 0.002, 0.007 and 0.001), respectively. The independent predictors of RVD were demonstrated to be tachycardia, lower systolic blood pressure and CHA2DS2-VASc score (P value = 0.022, 0.007, 0.021), respectively. The CHA2DS2-VASc score predicted the presence of RVD with 66.7 % sensitivity and 78.6% specificity as demonstrated by the receiver operating characteristic (ROC) analysis, with area under the curve (AUC) of 0.776 (CI 0.636-0.882, P value < 0.001). This study demonstrated no statistically significant difference between the different risk groups regarding the in-hospital mortality. Conclusion: Being independent of other factors, the CHA2DS2-VASc score can be used as a new, simple, and reliable tool to predict the development of RVD in patients with acute PE.